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lamya
Member
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Posted: Wed Sep 9th, 2009 07:48 am |
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Dr. Lee,
I'm still confused for the best decision , I would like to do it as soon as possible but I would like it to be reasonably long enough so I don't have to do it more than once to get a good result, I remember you told me that external fixator is my other good option to conceder.
According to my case ( this is my real name ) and my age( 48), AS SPECIALIST IN BRACHY SURGERY, which option would you think it will be better in my case here.
I really appreciate giving me your opinion to help me decide what is the best for me.
Thanks a lot.
Lamya
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ninini NJ
Member
| Joined: | Fri May 8th, 2009 |
| Location: | |
| Posts: | 3 |
| Mana: |  |
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Posted: Sat Sep 12th, 2009 09:14 pm |
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BracymetataWhat
How u doing, I had my surgery done with Dr Doolan as well. But I had it done in NJ he has two offices in NJ. Dr. Doolan is great, he tells you truth and I like that.
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lamya
Member
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Posted: Sun Sep 13th, 2009 01:44 am |
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Hi ninini NJ,
what you mean by Dr. Doolan "telling truth", how long ago did you have your surgery, and are you happy with the result, was it too painful, and do you have the before and after pics please.
thanks a lot and congratulations for having the surgery.
wish you all the best.
Lamya
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lamya
Member
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Posted: Sun Sep 13th, 2009 01:44 am |
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Last edited on Sun Sep 13th, 2009 01:44 am by lamya |
leepodiatry
Administrator
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Posted: Sun Sep 13th, 2009 09:10 am |
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Dear Lamya,
I read your comments regarding Dr. Doolans recommendation that if your toe is too short then go with external fixation. I need clarification. Does he mean that if the bone in the toe (phalanges) is too short (in addition to your metatarsal) then you should go with external fixation? Or, is he just referring to the fact the the toe looks short on the outside and he recommends external fix for all cases?
Let me clarify this extremely important issue. If your condition involves both a short metatarsal and a short toe bone (phalanx or phalanges) then whether you use one-stage or external fix is irrelevant. You still need two procedures. One for the short metatarsal and one for the short toe bone. Many surgeons have tried to compensate for the short toe bone by lengthening the metatarsal more than the proper length ( length which matches the other 4 metatarsals- called the metatarsal parabola). This is a serious mistake and often leads to a painful ball of the foot, stiffer toe and revisional surgery. Every year I consult on patients with which this had be done and the damage to the joint and the toe itself is significant. Therefore, please be extremely concerned about the promise of one surgery if two are really needed.
Many patients are afflicted with both a short metatarsal and phalanx, however, only one in ten ever have the short toe corrected. This is because the majority are satisified with the correction obtained just from the metatarsal lengthening and they feel that the extra 3-4mm of toe length are not significant enough to do anything about it. As such, when I review my patient's xrays during the consultation I always point this fact out.
You asked me which one, in my opinion is better in your case. I reviewed your case with you and told you that I recommended the one stage. This is was for several reasons. First, your length of correction was less than 19mm. Although I perform both ext fix and one stage, I prefer one-stage for corrections less than 19mm-20mm. One-stage for this amount of correction offers: 1. simpler post operative management with less complications short and long term. 2. primary bone healing with a stronger bone interface in less time. 3. Less post operative pain overall. 4. More consistent results that you can see right away. This is reported and supported in a research article by Choi, Chung and Baek in the Journal of Pediatric Orthopedics, 1999, and by research by Baek, et al in 1998 and 1999, plus others.
With Ext Fixation you can obtain better results when corrections above 20mm are required. And, in some cases, weight bearing is allowed sooner than with one stage. These are the primary advantages of ex-fix. However, the complication rate of ext Fix is higher due to: 1. higher post operative maintanence by patient causing complications: dislocation, infection, fractures. 2. Surgeon error in the fixator placement which has a high learning curve for proficiency and most surgeons don't perform very many of them to be proficient. The research by Sim & Park , Journal of Pediatric Orthopedics, 2006 revealed a complication rate of 23.1% . Far higher than what I have experienced with one-stage corrections.
So from my experience (over 200 cases) and the research to substantiate this, I see one-stage as the best choice for corrections under 19-20mm.
I hope this helps to clarify and not confuse. If you have any other questions please let me know either by forum, email or phone consultation (Call my office and speak with Liz to set that up as before).
Best Always,
Dr. Lee
Last edited on Sun Sep 13th, 2009 09:13 am by leepodiatry |
lamya
Member
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Posted: Wed Sep 16th, 2009 05:53 am |
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Dear. Dr.Lee,
thank you very much for answering my questions.
there was one question you asked me about Dr. Doolan's advice about when to use the external fixator, I think he was talking in general about the short metatarsal bone because he didn't have my x rays or my feet photos, I believe he meant exactly like you explained earlier about the cadaver bone which can be used in instances where the length on bone used is less than 1 cm, he said he will discuss it some more when he receive my x rays and let me know exactly what he thinks in my case.
I would like to thank you one more time for answering my questions because it will help me a lot to make the best decision for myself.
Lamya
Last edited on Wed Sep 16th, 2009 05:54 am by lamya |
rightandleft
Member
| Joined: | Mon Feb 2nd, 2009 |
| Location: | New York |
| Posts: | 135 |
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Posted: Mon Sep 28th, 2009 04:19 am |
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Brachymetawhat
how are you doing with your recovery, can you post some pictures thank you
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rightandleft
Member
| Joined: | Mon Feb 2nd, 2009 |
| Location: | New York |
| Posts: | 135 |
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Posted: Wed Oct 7th, 2009 03:21 am |
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Hi Lamya
Did you make a decision yet with what Dr or procedure to go with. You should also contact Dr Dror Paley, he's an expert in limb lengthening, he's located in Palm Beach, Florida. I read that someone back in 2006 had a brachy surgery with him and OHIP paid for it. He also does both feet at the same time.
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lamya
Member
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Posted: Thu Oct 8th, 2009 02:15 am |
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Hi rightandleft,
I have contacted with him by e mail, even though I told him I'm Canadian, he didn't mention anything about OHIP, he said he can do both @ the same time like you said.
I believe I'm leaning to words doing it with Dr. Lee " back again" because as he mentioned that I need around 18-19mm which to me will be a very good length to achieve and only one surgery to go through.
to be honest with you, it is a big decision to make, so I'm still in a "thinking"process.
what about you, did you decide which way to go ??
GL
Lamya
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rightandleft
Member
| Joined: | Mon Feb 2nd, 2009 |
| Location: | New York |
| Posts: | 135 |
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Posted: Thu Oct 8th, 2009 02:29 am |
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Lamya
I spoke to Dr Paley a few days ago, I like the fact that he does both feet at once and that you can weight bare right after the surgery- but he doesn't accept my insurance,
Like yourself I am not ready for the procedure because of the healing time, but I know that I have to do it one of these days.
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LHR32
Member
| Joined: | Thu Jul 17th, 2008 |
| Location: | New York USA |
| Posts: | 59 |
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Posted: Mon Oct 12th, 2009 07:13 am |
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| brachymetwhat i am so happy you went to Dr. Doolan is he not amazing! he was so sweet about everything and i was able to call him day or night it didnt mattter he always answered or got back to me asap. My parents were so hesitate about me doing this but my mother and i had 1 consultation with him and she was completely put at ease. He knows so much about the topic and is so dedicated to making sure everything is done right. I would recommend him to anyone he truly is an outstanding doctor! He was whilling to work around the fact that i was starting college in another state and scheduling things to make sure everything turned out as planned. If anyone looking to do the surgery cant find a dr and is remotely in the ny area i say go with Dr. Doolan! you will not regret it!
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brachymetaWHAT
Member
| Joined: | Thu Aug 27th, 2009 |
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| Posts: | 12 |
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Posted: Mon Oct 12th, 2009 08:19 pm |
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Hi sorry i haven't answered in forever Ive been really busy. Everything's going good I cannot wait to get out of these medical shoes!
I got the pins out of the first foot on September 28th. I am getting the stitches out on thursday!
I am getting the pins out of the second foot (my last of 4 surgeries) the second week on November and i stopped turning 5 days ago.
I will post all the pics after the last surgery.
LHR32- yes he is amazing all it took for me was one consultation and i was booked also! how long did it take you to be able to wear heels? could you wear normal shoes right after you got the stitches out?
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rightandleft
Member
| Joined: | Mon Feb 2nd, 2009 |
| Location: | New York |
| Posts: | 135 |
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Posted: Sat Oct 31st, 2009 03:20 am |
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Hi Brachymetatawhat
how are you doing, can you post your photos if you can
thank you
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